BELGIAN CONSENSUS MEETING on TRAVEL MEDICINE. June 20, 2014

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1 BELGIAN CONSENSUS MEETING on TRAVEL MEDICINE June 20, 2014 Belgian Scientific Study Group on Travel Medicine PART 1b malaria version 05/11/2014 Pr. A. Van Gompel (ITG) Pr. F. Jacobs (Hôp. Erasme, ULB) Pr. P. Lacor (UZ-Brussel) Dr. Ph. Leonard (CHU-ULg) Pr. W. Peetermans (U.Z. - K.U.Leuven) Pr. S. Callens(UZ.- U.Gent) Dr. S.Quoilin (iph.fgov.be) Dr.P. Soentjens (Belgian Defence) Pr. B. Vandercam (CHU. St. Luc, UCL) Pr. Y. Van Laethem (CHU. St. Pierre, ULB) 2014 REPORT BELGIAN CONSENSUS MEETING on TRAVEL MEDICINE June 20, 2014 PART 1b The consensus meeting was chaired by A. Van Gompel and Y, Van Laethem A preliminary PowerPoint, prepared by A. Van Gompel, was presented The discussion and recommendations of the meeting are included in this finale presentation. The ESSENTIAL SLIDES (pdf-version) & the CONSENSUS BROCHURE (in Dutch and French) highlighting the proposals for changes will been sent to all participants. May be used for teaching. These documents will serve as a proposal for approval by the governmental Belgian Health Council section Vaccinations, on Responsable final redaction : A. Van Gompel 1

2 2014 PART 1 1.a - Vaccination for Yellow Fever 1.b - Malaria PART 2 2.A - Other vaccinations 2.B - TD, other infections,., 2.C - VARIA 2

3 Malaria WHO Only a few chapters are updated 2014 Only these chapters are updated They are freely downloadable 3

4 Malaria The guidelines for malaria have not really changed in

5 2014 zone A 2011 = 2012 = 2013 A C 2014 C 2014 the Belgian guidelines are not changing yet 5

6 WHO = 2013 =

7 2012 = 2013 = 2014 Low risk malaria areas 7

8 TO DOWNLOAD 8

Noodbehandeling Traitement d urgence Prevention d urgence??? Noodpreventie?

9 In low risk malaria areas? Switzerland / Germany / Austria : Belgium : SBET = Standby emergency treatment Noodbehandeling Traitement d urgence Prevention d urgence??? Noodpreventie??? Is not correct, Better : Chimioprophylaxie / Chemoprofylaxe on demand Switzerland Germany Austria.SBET only since more than years 9

10 Switzerland Germany Austria.SBET only since more than years Lectures on Malaria India NECTM 5 Bergen Norway Malaria-risk for the local population in India is grossly underestimated by official WHO numbers However for most travelers the risk is very low to negligible Breakpoint = Areas of low transmission = where the reported malaria case incidence from all species was < 1 per 1000 (persons within the local population) per year we should adopt the malariaguidelines of the German speaking countries 10

11 Lectures on Malaria in India NECTM5 Bergen Norway 11

12 Rigid USA position about e.g. Mumbai - India.but David Shlim is a wise American From: Travel Medicine Clinical Discussion List [mailto:travelmed@yorku.ca] On Behalf Of David Shlim Sent: woensdag 14 mei :17 Subject:.. about whether to recommend malaria prophylaxis for a visitor to Mumbai and Agra in October The discussion is illustrative of one of the key unresolved issues in travel medicine. Merely knowing the risk or the potential for risk is not enough. There is a threshold of risk for some diseases that remains subjective. Is the goal of malaria prophylaxis : to prevent any possible case of malaria (as has been the thrust of CDC advice), or is it to strike a balance of protection and likelihood when the risk is very low? When one takes into account the actual likelihood of malaria, then one has to confront the concept of threshold at what level of risk is it worthwhile to recommend prophylaxis. Is it a risk of 1/1000, 1/10,000, 1/100,000, or 1/1,000,000? Rigid USA position about e.g. Mumbai - India.but David Shlim is a wise American From: Travel Medicine Clinical Discussion List [mailto:travelmed@yorku.ca] On Behalf Of David Shlim Sent: woensdag 14 mei :17 Subject:.. about whether to recommend malaria prophylaxis for a visitor to Mumbai and Agra in October It would seem that the traveler should be a participant in making a decision about prophylaxis in circumstances that one could call minimal risk. The risk is not zero, but it is so low that some people will elect not to take prophylaxis (and some people will elect to take prophylaxis). In most of Africa, the risk of malaria is so significant that this type of discussion is not appropriate. However, in many parts of India, Central and South America, and SE Asia, it is appropriate. There may be no right answer in these situations. India is a complex risk situation, with the overall number of cases in returning travelers to US on the increase, mainly in the VFR population. However, it is difficult to find case reports of malaria that occurred in non-vfr travelers who only visited an urban area. Warmly, David David R Shlim MD President, ISTM Jackson Hole, Wyoming 12

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14 UK malariaguidelines 2014 Short description of the changes since acmp_ htm 14

15 Antimalarials in pregnancy breastfeeding Antimalarials & Pregnancy & Breastfeeding 2014 UK France 15

16 Antimalarials & Pregnancy & Breastfeeding 2014 Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave Medasso / IMT Conseils de santé pour voyageurs Edition Antimalarials & Pregnancy & Breastfeeding 2014 Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave Medasso / IMT Conseils de santé pour voyageurs Edition

2014-2015 Medasso / IMT Conseils de santé pour

17 Antimalarials & Breastfeeding 2014 Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave Medasso / IMT Conseils de santé pour voyageurs Edition Mefloquine precautions 17

2014 Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave 2014-2015 Medasso / IMT Conseils de santé

18 2014 Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave Medasso / IMT Conseils de santé pour voyageurs Edition Roche - Lariam Obligatory patient alert card to share with the clients 18

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20 Stop atovaquone-proguanil earlier after return? Only Exceptionally this might be an option, if the patient remains under supervision for at least 4 weeks In Israel atovaquone/proguanil may be stopped the day after return from sub- Saharan malaria-endemic region BUT.. read carefully the JTM article & the thoughtful editorial 20

.. read carefully the JTM article & the thoughtful JTM editorial In Israel atovaquone/proguanil may be

21 In Israel atovaquone/proguanil may be stopped the day after return from sub- Saharan malaria-endemic region BUT... read carefully the JTM article & the thoughtful JTM editorial In Israel atovaquone/proguanil may be stopped the day after return from sub-saharan malaria-endemic region IT IS MUCH TO EARLY TO CHANGE THE GUIDELINE Exceptional situations people who forgot to continue for 7 days what s the minimum?,,, 21

22 Lariam & obesity 2014 Medasso-Headlines Gezondheidsadviezen voor reizigers Uitgave Medasso-Headlines Conseils de santé pour voyageurs Edition

23 Riamet & Eurartesim 2014 Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave Medasso / IMT Conseils de santé pour voyageurs Edition

24 EC & BIOCIDES 2014 Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave Medasso / IMT Conseils de santé pour voyageurs Edition

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26 Some permethrine solutions available in Belgium (not exhaustive) Pistal = permethrine 0,2 % spray (pharmacist) BioKill = permethrine 2,2% 500 cc (chemist s shop, brico shop) Not yet available anymore? Back in the near future? : Mouskito Textile Spray Qualiphar (permethrine 6%, 100 ml, pharmacist) Insectal Nycomed (permethrine 0,25%, 150 ml, pharmacist) BugProof Nomad Medical Tropicare (permethrine 0,5%, 100 ml outdoor-sport) 26

27 2013 End Malaria 27

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BELGIAN CONSENSUS MEETING on TRAVEL MEDICINE June 26, 2015

BELGIAN CONSENSUS MEETING on TRAVEL MEDICINE June 26, 2015 Belgian Scientific Study Group on Travel Medicine PART 1b malaria version 25/11/15 Pr. A. Van Gompel Dr. U Maniewski (ITG) Pr. F. Jacobs (Hôp.